Markers of increased atherosclerotic risk in patients with chronic kidney disease: a preliminary study.
Markers of increased atherosclerotic risk in patients with chronic kidney disease: a preliminary study.
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慢性肾脏疾病患者动脉粥样硬化风险增加的标记：初步研究。
DOI：
10.1186/s12944-016-0191-x
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发表时间：
2016-02-03
影响因子：
4.5
通讯作者：
Rysz J
中科院分区：
文献类型：
--
作者：
Gluba-Brzózka A;Michalska-Kasiczak M;Franczyk B;Nocuń M;Toth P;Banach M;Rysz J
慢性肾脏疾病的患病率持续上升。心血管疾病是慢性肾病患者死亡和过早死亡的主要原因之一。即使是最早期的慢性肾脏疾病也与随后冠心病的高风险相关。本研究的目的是确定CKD中动脉粥样硬化风险增加的标志物。研究组共包括80名患者（20名I/II期CKD患者，20名III期CKD患者，20名IV期CKD患者和20名V期/透析患者）和24名健康志愿者。测定CKD患者骨保护素、骨桥蛋白、骨钙素、基质γ-羧谷氨酸蛋白、胎蛋白A、MMP-2、MMP-9、TIMP-1、TIMP-2等蛋白水平及生化指标，分析其对动脉粥样硬化风险的影响。心脏超声心动图评估结构完整性和功能、左心室肥厚、收缩和舒张功能障碍的存在。本研究表明，CKD患者心室肥厚（95.3%）和舒张功能障碍（93.2%）的患病率很高。E / E”率明显高于(13.6±4.4,p = 0.001),三尖瓣闭锁不全(27.3 CKD I / II与CKD的71.4 V, p = 0.016),收缩功能障碍(33.3 CKD I / II与CKD的78.9 V, p = 0.040),二尖瓣钙化(0 CKD I / II与CKD的28.6 V, p = 0.044),主动脉瓣钙化(0 CKD I / II与CKD的61.9 V, p = 0.0008)明显更频繁的CKD患者阶段V /透析比其他组。仅MMP-2、MMP-2/TIMP-2比值及TIMP-1组间差异有统计学意义。本研究显示CKD患者心室肥厚和舒张功能不全的发生率很高。HD患者的收缩功能障碍、二尖瓣和主动脉瓣钙化明显高于其他CKD分期的患者。MMP-2、MMP-2/TIMP-2比值显著升高，TIMP-1降低，提示这些因素可能参与了CKD患者动脉粥样硬化的发病机制。
The prevalence of chronic kidney disease is rising continuously. Cardiovascular disease is among leading causes of death and premature mortality of patients with chronic kidney disease. Even the earliest stages of chronic kidney disease are associated with higher risk of subsequent coronary heart disease. The aim of this study was to determine markers of increased risk of atherosclerosis in CKD. The study group consisted of a total of 80 patients (20 patients with stage I/II CKD, 20 with stage III CKD, 20 stage IV CKD and 20 stage V/dialysis) and 24 healthy volunteers. Levels of proteins (osteoprotegerin, osteopontin, osteocalcin, matrix γ-carboxyglutamic acid protein, fetuin A, MMP-2, MMP-9, TIMP-1, TIMP-2) and biochemical parameters were measured to analyse their influence on atherosclerosis risk in CKD patients. Cardiac echocardiography was performed to assess structural integrity and function, presence of left ventricular hypertrophy and systolic and diastolic function dysfunction. This study shows that the prevalence of ventricular hypertrophy (95.3 %) and diastolic dysfunction (93.2 %) in CKD patients is high. Also E/E’ ratio was significantly higher (13.6 ± 4.4, p = 0.001), tricuspid insufficiency (27.3 in CKD I/II vs. 71.4 in CKD V, p = 0.016), contractile dysfunction (33.3 in CKD I/II vs. 78.9 in CKD V, p = 0.040), mitral valve calcification (0 in CKD I/II vs. 28.6 in CKD V, p = 0.044) and aortic valve calcification (0 in CKD I/II vs. 61.9 in CKD V, p = 0.0008) were significantly more frequent in patients with CKD stage V/dialysis than in other groups. Only MMP-2, MMP-2/TIMP-2 ratio and TIMP-1 differed significantly between groups. This study shows high prevalence of ventricular hypertrophy and diastolic dysfunction in CKD patients. Contractile dysfunction, mitral and aortic valve calcification in HD patients were significantly more frequent than in patients with other CKD stages. Significantly increased levels of MMP-2, MMP-2/TIMP-2 ratio and lower TIMP-1 suggests that these factors may be involved in the pathogenesis of atherosclerosis in CKD patients.